MOTOR DISEASES
1) About 12 days after a mild upper respiratory tract infection, a 12 year old boy complains of weakness in his lower extremities. Over several days, the weakness progress to include hid hand. On examination he has the weakness described and no lower extremity deep tendon reflex, muscular atrophy or pain. Spinal fluid studies are notable for elevated protein only. likely diagnosis would be
A. Bell palsy
B. Muscular dystrophy
C. Guillen barre syndrome
D. Charcot marie tooth disease
E. Werdnig Hoffman disease
2) 5 year old boy presented with progressive lower limb weakness for 3 days. one week after starting school. an examination lower limb power G 2. leg reflex absent. no bladder symptoms. indication for viral isolation.
a. to identify surveillance
b. possible diagnosis of polio
c. to exclude the polio
d. to identify the immunization problem
3) Regarding Guillain Barre Syndrome
a) CSF protein characteristically reduces in amount with progression of diseases
b) It is an illness ascending asymmetrical type of muscle weakness
c) This is An autosomal recessive condition
d) There is no change in bowel or bladder function
e) Immunoglobin infusion is preferable to plasma exchange
4) 5 year old child with TOF presented with progressive right side hemiparesis after diarrhea. Most likely diagnosis?
a) Left middle cerebral artery thrombosis
b) Left middle cerebral artery embolism
c) Left middle cerebral artery septic emboli
d) Left cerebral abscess
e) Left cerebral hemispheric infraction
5) A grade 1 student present with bilateral lower limb flaccid paralysis, areflexia and no bladder involvement 1 week after school admission. What is the most appropriate reason for you to send his stool samples for polio virology?
a) To confirm case of polio
b) To exclude cases of polio
c) To detect vaccine derived poliomyelitis following school admission
d) To follow polio surveillance guidelines
e) To make measures to prevent spreads of polio to other students
6) About 12 days after a mild upper respiratory tract infection, a 12 year old young boy complains of weakness of his lower extremities. Over several days the weakness progress to include his trunk. On the examination, he has the weakness described and no lower extremity deep tendon reflexes, muscular atrophy or pain. Spinal fluid studies are notable for elevated protein only. The most likely diagnosis would be,
a) Bell’s palsy
b) Muscular dystrophy
c) Guillen barre syndrome
d) Charcot maries tooth disease
e) Werdnig Hoffman disease
7) Guillain- Barre syndrome
a. Is associated with asymmetrical flaccid paralysis
b. Is an ascending paralysis
c. Is associated with sensory deficits
d. Is treated with immunoglobulins
e. Leads to permanent brain damage
CNS INFECTIONS
1)18 month old child presented with a 6 days history of fever, vomiting, irritability and dry cough. She was treated with oral antibiotics by several practitioners prior to admission. Result of CSF analysis: Appearance-colourless, protein-80mg/di, sugar 40mg/dl, cells:Neutrophil-25, lymphocyte-40, RBS-100. Basic investigation to identify underlying causative organism,
a. Bacterial antigen test in CSF
b. Blood culture and ABST
c. CSF culture and ABST
d. CSF direct smear and gram stain
e. CSF direct smear and Zilch-Nelson stain
2).months old boy having a dry cough presented with fever and drowsiness. He was previously treated by a GP with oral antibiotics. CSF full report; colourless, glucose 40mg/dl, protein elevated, lymphocytes- 60%, polymorphs-high, RBS-100mg/dl.
What is the best investigation to diagnose?
a) Detection of bacterial antigens in CSF
b) Blood culture and ABST
c) CSF for culture and ABST
d) CSF for gram stain
e) CSF for Zeil-Neilson stain
3) CSF analysis?
a. Increased polymorpho nuclear leucolytes in bacterial meningitis
b. Decreased sugar in tuberculosis meningitis
c. Protein increased in viral infection
d. Lymphocytes predominant in TB meningitis
e. Mycobacterium on gram stain
4). 1 year old girl presented with left sided weakness and dilated left pupil while treating for meningitis. Lumbar puncture: appearance turbid, lymphocyte 75, neutropil 5, protein 3000[15-40), glucose 3 mmol, gram stain organism, culture- no growth, ESR-120, imaging revealed calcified region in the right cerebral cortex. Which of the following is the likely dx?
a. Viral encephalitis
b. SSPE
c. meningitis with abscess
d. Bacterial encephalitis
e. Aseptic meningitis
5) In a suspected case of Meningitis
a. Treatment should be with held to confirm the diagnosis
b. LP is done without local anesthesia If the child not responding pain
C Delay until the FBC report is available
d. Presence of lung signs makes diagnosis unlikely
e. Immunization history is of no value
6) Regarding clinical presentation of meningitis?
a) Neck stiffness is more useful sign in 1 year old child with meningitis.
b) Seizures occur in 50% of patients.
c) Fever is not always present at presentation in acute bacterial meningitis.
d) Bulging or tense anterior fontanella is a useful sign in young infants.
e) Papilloedema is rare in acute uncomplicated bacterial meningitis.
7) A nine year old boy was admitted to the paediatric ward with tingling sensation of both lower limbs for 2 days duration.On the day of admission, he had a fall while climbing stairs. On examination, lower limb power was grade 3. Few hours later he complained of difficulty in breathing What is the most likely etiological agent for this child's problem?
a) Polio virus
b) Clostidium botulinum
8). Regarding management of CNS infection in children
a.) Gp-B Streptococcal infection treated for 21 days of antibiotics
b). Close contact of Meningococcal meningitis should receive prophylaxis
c.)Multiple cranial nerve involvement is seen in TB meningitis
d.) Herpes virus infection leads to temporal sclerosis
e.)HSV encephalitis should need Hearing assessment
9) A 3 month old baby with bacterial meningitis is on IV cefotaxime. In spite of the above treatment she continued to have fever spikes and looked unwell. What is the most appropriate next step in the management at this stage?
a) Change the antibiotics to a higher spectrum
b) Request a repeat CRP and FBC
c) Request an USS brain
d) Refer for neurosurgical opinion
10) Regarding management of CNS infection in children
a). Gp-B Streptococcal infection treated for 21 days of antibiotics
b.) Close contact of Meningococcal meningitis should receive prophylaxis
c)Multiple cranial nerve involvement is seen in TB meningitis
d). Herpes virus infection leads to temporal sclerosis
e). HSV encephalitis should need Hecring assessment
11) Which of the following can occur as the complication of Bacterial meningitis?
a) Waterhouse-Friderichsen syndrome.
b) Cerebral abscess.
c) Necrotizing enterocolitis.
d) Purpurafulminans.
e) Spinal muscular dystrophy.
12)Prophylactic antibiotics are indicated for close contacts of a patient with meningitis when the aetiological agent is
a) Streptococcus pneumoniae
b) GBS
c) H.influenza type b
d) E.coli
e) Neisseria meningitidis
13) Niesseria meningitidis
a) Is a gram negative cocci
b) well sensitive to macroiides
c) is a common cause of aseptic meningitis
d) commonest cause for pre school age meningitis
e) can cause severe respiratory distress
14). 10 year old girl presented with left sided weakness and dilated left pupil while treating for meningitis. lumbar puncture- appearance turbid, lymphocyte 75, neutrophil 5, Pr 3000 (15-40), glucose 3 mmoles , gram stain no Organism, culture-no Growth. ESR- 120. imaging study revealed calcified lesion in the right cerebral cortex. WOF is the likely diagnosis
a) viral encephalitis
b) SSPE
c) bacterial meningitis with Abscess
d) herpetic encephalitis
e) TB meningitis
15) 18 month old boy having a dry cough presented with fever and drowsiness. he was previously treated by GP with oral antibiotics. CSF full report; colorless, glucose 40 mg/dL, protein- elevated, lymphocytes60%, RBS- 100 mg/dL.
What is the best investigation to diagnose?
a) Detection of bacterial antigens in CSF
b) blood culture an ABST
c) CSF for culture and ABST
d) CSF for gram stain
e) CSF 4 Zeil- Neilson stain
16) Regarding rabies
a) Domestic rat have been implicated in the transmission of rabies
b) Rabies virus will penetrate the intact mucus membrane
c) Vaccination give 100% sero-conversion
d) Sensitivity test should be done before giving human rabies immunoglobulin
e) If patient develops reaction to rabies immunoglobulin should not give IV hydrocortisone
17) Clinical features more favors of herpes simplex encephalitis:
a) Involve frontal and temporal lobe
b) Focal convulsion
c) Focal change in EEG
d) Presence of RBC in non traumatic CSF
e) Increased C reactive protein
UNCONSCIOUS PATIENT
1) A 3 year old girl is presented with a sudden onset LOC. she's having multiple bruises over the trunk, what is the next step in the Mx?
a) Urgent CT brain
b) skeletal survey
c) Judicial medical referral
d) start head injury observation
e) order and EEG
2) A 2 year old child admitted because of weakness proceeding to coma. According to the parents, he had been well until several hours prior to admission, when they noted diarrhoea, cough, wheezing and sweating. Physical examination reveals a comatose child with diffuse weakness. Pupils are pinpoint and unresponsive. Examination of the chest reveals generalized wheezing. Oral secretions are copious. Which of the following should you administer at this time
a) Adrenaline
b) Atropine
c) Cefotaxime
d) Methylprednisolone
e) Edrophonium
CEREBELLAR DISEASE
1) 4 year old girl presented with torticollis and ataxia for 3 weeks. On examination she is irritable, head deviation, ataxia, past pointing, dysdiadokokinaesia. Bp 120/80, pr 60, what is the diagnosis?
a) Transverse myelitis
b) Meduloblastoma
c) Fedrich ataxia
d) Dystonic reaction to drug
e) Viral encephalitis
SEIZURE
1) A 2 week old baby born by Em LSCS presented to the hospital with 2 episodes of seizures and feeding also not well for 12 hours duration. Baby is drowsy. Temperature 35.5°C Blood glucose – 40mg/dl S.calcium – 8.2mg/dl(NL 8.2-10.9) S.Na+ - 132mmol/l(NL 130-142) S.K+ - 4.3mmol/l(NL 3.2-5.2) What is the most likely diagnosis?
a) Hypoglycaemia
b) Meningitis
c) Hypocalcaemia
d) Hyponatremia
e) Hypoxic ischemic encephalopathy
2) A eight month old child was seen with inconsolable cry and one episode of seizure and feeding febrile and recent scar was noted on his anterior chest. Further examination revealed, full fontanelle and reduced movements in right upper limb. Above findings are more consistent with,
a) Acute pyogenic meningitis
b) Viral encephalitis
c) Non accidental injury
d) Space occupying lesion
e) Cerebral oedema
3). Regarding simple febrile convulsions
a) Occur after the 1st 48 hours of the illness
b) Long term anti-epileptics are indicated
c) Can cause status epilepticus
d) Requires neuro imaging
e) Contraindication for DPT vaccination
4). Febrile fits
a. Fit with low grades of fever indicate higher risk of recurrence
b. Fits lasting more than 30 minutes should be treated with IV antibiotics
c. Fits within few hours of fever should be evaluate for meningitis
d. Risk of neurological impact can be reduces by AED
e. Are common among children with neurological impairment
5). An 18 month old child presents to the emergency centre having had a brief, generalized tonic clonic seizure. He is now postictal and has a temperature of 40C. during the lumbar puncture (which proves to be normal) he has a large watery stool that has both blood and mucous in it. The most likely diagnosis in this patient is
a. salmonella
b. enterovirus
c. Rotavirus
d. campylobacter
e. Shigella
6). A 2 year old child presents with fever and one episode of generalized tonic clonic seizure of 5 minutes duration. Most appropriate management ache. time of discharge is.
a) Start sodium valproate from next seizure
b)Reassure
c) Inform mother about the increased risk of developing epilepsy
7) Features to differentiate pseudo seizures from epileptic seizures
a.gradual onset
b. pelvic thrusting
c. cyanosis
d. body roling
e. tongue biting
8) Epilepsy
a) Recurrent uncontrolled discharge of electrical activities should result in motor manifestations.
b) Should be treated with AED
c) Hypocalcaemia may be the cause
d) Schooling should be avoided
e) May develop fits with fever
9) In the management of tonic convulsions (status epilepticus)
a) Measuring blood glucose is not important
b) Diazepam IV can be given
c) If not responding for first bolus of diazepam phenytoin IV should be given
d) Defined as seizure lasting more than 30 mins
e) Paraldehyde is given IM
10) Correctly matched pair
a) Absence seizure – sodium valproate
b) Infantile spasms – prednisolone
c) Myotonic seizure – phenobarbitone
d) Status epilepticus – phenytoin
e) Temporal lobe epilepsy – ethosuximide
11) Following are commonly matched
a) Déjà vu – temporal lobe epilepsy
b) Night terrors – petite mal
c) Vacant episodes – abscense seizures
d) Aura of fear – benign rolandic epilepsy
e) Development regression – west syndrome
12) A 4 year old girl presented with a GTC convulsion. She had abdominal pain and watery stools with mucus for 3 days. She has not passed urine for 12 hours. Tempersture was 37.20C, WBC – 30000/mm3 ( N – 82% , L – 18% , platelets – 110,000/mm3 ). What feature in the blood picture will confirm the diagnose?
a) Burr cells with acanthocytes
b) Heinzbodies with polychromasia
c) Marked anisopoikilocytosis
Hypertension (HTN)
1. Regarding systemic hypertension
a) Low birth weight is associated with adult hypertension
b) Peripheral vascular disease is a complication
c) Can be caused by excessive intake of alcohol
2. A 25 yr old male presents with a BP of 180/110 mmHg. WOTF investigations will help to find out a cause
a) ECG
b) USS abdomen
c) Estimation of urinary catecholamines
d) Serum Electrolytes
e) Chest X ray
3. Regarding malignant hypertension,
a) Headache is a typical feature
b) Papilledema is common
c) Intravenous nitrate is contraindicated
d) Blood pressure should be brought down to normal levels within 10 minutes
e) Essential to look for secondary causes
4. Following drugs are appropriate for management of chronic hypertension,
a) Captopril
b) Verapamil
c) Spironolactone
d) Digoxin
e) Metaprolol
5. Treatment of hypertension.
a) Calcium Chanel blockers are contraindicated in patients over 65 y.
b) Spironolactone is recommended in resistant HT
c) Combination of ACEI & ARB best avoided
d) Methyl dopa is contraindicated in pregnancy
e) Weight reduction alone decrease BP
6. Which of the following statements regarding hypertension is/are true?
a) ACEI is drug of choice in HTN associated with systemic sclerosis
b) ARB is contraindicated in diabetic nephropathy
c) Prazocin causes postural hypotension
d) CCB are safe during pregnancy
e) Thiazides are contraindicated in elderly
7. 22 yr old girl with BP-160/100 mmHg. Which of the causes are correctly matched,
a) Hypokalemia – Crohn’s disease
b) Café au lait spots – pheochromocytoma
c) Short lower limbs – coarctation of aorta
d) Presence of red cells – renal artery stenosis
8. Review of the patient's medical records showed that her systolic blood pressure was greater than 140 mmHg at both of her last clinic appointments. Her medical history is otherwise significant only for diabetes mellitus. Today her blood pressure is 160/90 mmHg. What is the best next step in her blood pressure management?
a) Ask the patient to keep written records of her blood pressure and bring with her to the next appointment
b) Advise the patient to begin a heart healthy, low sodium diet and refer to a nutritionist.
c) Prescribe an ACE inhibitor in addition to heart healthy life.
d) Prescribe a calcium channel blocker in addition to a heart healthy diet.
e) Arrange for echocardiogram to assess for end organ damage.
9. A 67 years old male patient presents to your clinic to establish primary care. He is asymptomatic and he has a history of hypertension for which he takes a thiazide. His father had a myocardial infarction at age of 62. The patient smoked until 5 years ago, but has been abstinent from tobacco since then. His blood pressure is 130/80 mmHg. Aside from being over-weight, the remainder of the physical examination is unremarkable. Which of the following preventive health interventions would be most appropriately offered to him today?
a) Carotid ultrasound to evaluate for carotid artery stenosis.
b) Abdominal ultrasound to evaluate for aortic aneurysm.
c) Lipoprotein assay to evaluate coronary heart disease risk.
d) Exercise (treadmill) stress testing to evaluate for coronary artery disease.
e) Homocysteine level to evaluate coronary heart disease risk.
10. A 25 year old previously healthy school teacher underwent pre employment screening and found to have elevated blood pressure. Her blood pressure recording for 2 weeks in various occasions ranged from 160/90 to 170/90 mmHg. Her other examinations were normal what is the least Important preliminary Investigation?
a) ECHO
b) ECG
c) Serum creatinine
d) Serum electrolytes
e) Urine albumin and sediments
Arrhythmia
1. Following is/are true of atrial fibrillation?
a) ASD is a known cause
b) has saw-toothed 'p' wave in ECG
c) often asymptomatic
2. Regarding atrial fibrillation
a) is more common with thyrotoxicosis due to Graves disease
b) Irregularity of the pulse is corrected after exercise
c) Presents as broad complex tachycardia
d) May occur in young individuals with no cardiac disease
e) Pneumonia is a known cause
3. Recognized features of atrial fibrillation are
a) Irregular pulse volume
b) Variable first heart sound
c) Fixed splitting of heart sound
d) Mid diastolic murmur at the apex
e) 4th heart sound
4. Features of a complete heart block,
a) Irregular cannon 'a' waves
b) Dissociation of P waves and QRS complexes on ECG
c) Varying intensity of first heart sound
d) Mid diastolic murmur at apex
e) Presents with syncopal attacks
5. T/F regarding complete heart block
a) Cannon waves seen in JVP
b) Digoxin improves the survival
c) Increase the incidence of systolic embolism
d) Insert a pace maker if anterior MI occurs
e) Can occur due to inferior MI
6. An 80 year old woman was admitted to the ward with dizziness. Cardiac monitoring initially revealed atrial fibrillation with rapid ventricular response. Her ventricular rate was controlled with beta blocker. An echocardiogram revealed an enlarged left atrium and an ejection fraction of 50%. No evidence of diastolic heart dysfunction was noted. She is now asymptomatic, with blood pressure 130/80 mmHg, heart rhythm irregularly irregular, and heart rate around 80 beats/min. Which of the following is the best management strategy of this patient's arrhythmia?
a) Electrical cardioversion plus prolonged anticoagulation
b) Electrical cardioversion without anticoagulation
c) Chemical cardioversion plus prolonged anticoagulation
d) Chemical cardioversion without anticoagulation
e) Continued rate control plus prolonged anticoagulation.
7. Which of the following suggest a VT than a SVT as the likely cause
a) QRS >0.14 s
b) Presence of capture beats
c) Irregular rhythm
d) Q waves in V1
e) History of angina pectoris
8. A 30 year old male had a blackout while exercise at the gymnasium and remained unconscious for about 2 min till he was revived by cardiac massage. Most appropriate investigation(s) to arrive at a diagnosis is/was?
a) Plain CT
b) ECG
c) ECHO
d) EEG
e) Holter monitoring
Valvular heart diseases
1. Regarding aortic stenosis
a) Pulse pressure is widened
b) Loud 2nd heart sound
c) Thrusting apex
d) Can present with angina
e) ECG may show LVH
2. Regarding aortic stenosis
a) Manifest as syncope
b) Is a complication of bicuspid valve
c) Associated with low volume pulse
d) Is the commonest valve involved in Rheumatic fever
e) Can manifest as angina
3. Mitral stenosis
a) Causes left ventricular failure
b) Heaving apex
c) Presystolic accentuation is prominent with atrial fibrillation
d) Slow rising pulse
e) Common in rheumatic fever
4. Mitral regurgitation
a) Acute rheumatic carditis can be a cause
b) Third heart sound signifies bad prognosis
c) Thromboembolism is less common than in MS.
d) May occur due to aortic valve disease
e) Murmur may radiate to the neck
5. Recognized signs of mitral regurgitation include,
a) Loud S1
b) Rumbling mid diastolic murmur at apex
c) Third heart sound
d) Parasternal heave
e) Reversed splitting of second heart sound
6. 55 year old patient with rheumatic valvular heart disease is admitted in confused state. Pulse is irregularly irregular. Pulse rate is 160. BP is 70/50. What is the most appropriate management of this patient?
a) IV amiodarone
b) DC cardioversion
c) IV digoxin
d) Infusion of Normal Saline
e) Infusion of dobutamine
7. 28 yr old man with known valvular heart disease presented with fever for 2 weeks duration and SOB. O/E temperature -38.3 C, harsh pansystolic murmur and mild bibasal crepitations. Blood cultures were taken. What is the most appropriate next step in Management,
a) ECG
b) IV antibiotics
c) throat swab
d) furosemide
e) 2D-Echo
8. A 79 year old female presents with recurrent falls and transient loss of consciousness for a few minutes. Most of these episodes occurred while she was walking. Examination does not show any focal neurological signs. Her pulse is regular and blood pressure is 110/90 mmHg. There is no cardiomegaly. Auscultation reveals an ejection systolic murmur best heard over the aortic area which radiates to carotids, what is the most appropriate investigation to find the cause for her presentation?
a) Contrast enhanced CT brain
b) EEG
c) ECG
d) Echocardiogram
e) Holter monitoring
ECG
1. Which of the following ECG abnormalities usually no need for specific treatment
a) First degree heart block
b) Sinus arrhythmia
c) Atrial flutter
d) Mobitz II 2° heart block
e) Wenckebach 2° heart block
2. Which of the following are correctly paired
a) ST depression & T inversion - digoxin toxicity
b) Short QT interval - hypo Ca2+
c) Prominent U wave - hypokalemia
d) Subarachnoid hemorrhage - T inversions in v2-v5
e) Tall p waves - hyper K+
3. Causes of tall R waves in V1
a) Wolf Parkinson white syndrome
b) LBBB
c) Right ventricular hypertrophy
d) Atrial fibrillation
e) Posterior MI
4. A 37 year old male with CKD presents with shortness of breath. His ECG reveals tall T wave and wide QRS complex. What is the next step in the management?
a) Dextrose IV
b) Hemodialysis
c) Calcium gluconate
d) Nebulize with salbutamol
e) Oral resin
Cardiomyopathies
1. True or false regarding dilated cardiomyopathy
a) Characterized by right ventricular dilation
b) Associated with thyrotoxicosis
c) Fourth heart sound
2. Regarding Infective Endocarditis
a) Staph epidermidis the commonest cause
b) Treated for 2 weeks
3. Causes of pericarditis
a) Uraemia
b) SLE
c) hypothyroidism
d) Dressler’s syndrome
4. Infective endocarditis (IE)
a) Acute IE cannot occur in normal valves
b) More common with increasing age
c) Staphylococcus is the commonest agent after cardiac surgery
d) Almost always leads to macroscopic hematuria
e) Manifest with hypochromic microcytic blood picture
CVS clinical signs
1. In JVP
a) ‘a’ wave indicates atrial contraction
b) There are 3 positive waves
c) V wave Indicates TR
d) V wave indicates SVC obstruction
e) a wave absent in atrial fibrillation
2. Regarding JVP
a) Increase with inspiration in constrictive pericarditis.
b) С wave correspond to iso volumetric contraction of the ventricles
c) Large V wave occur in tricuspid stenosis
d) a wave coincide with p wave in the ECG
e) Easily seen when the patient is supine if the patient has heart failure
3. Which of the following is compatible with BP 120/50 mmHg in right upper arm?
a) Aortic stenosis
b) MR
c) AR
d) PDA
e) VSD
4. Central cyanosis is more likely than peripheral cyanosis
a) If cyanosis is in pinna
b) cyanosis of nails at warm extremities
c) If cyanosis disappears with O2 therapy
d) If clubbing is present
e) SPO2<95 mmHg in
5. Clinical features of cardiac tamponade
a) Reduced JVP
b) muffled heart sounds
c) hypotension
d) bradycardia
e) pulses paradoxes
6. Regarding CVS examination
a) Pulses alterance – HOCM
b) Loud SI - 1st degree heart block
c) Reverse splitting of S2 - LBBB
d) Third heart sound – hypertension
e) Double impulse at the apex - aortic stenosis
Ischemic Heart Disease (IHD)
1) 55 years old man presented with severe central chest pain for 2 hours duration. ECG showed dome shaped (convex upward) ST elevations in the anterior chest leads. An ECG taken on the previous day was normal. Regarding this patient,
a) Acute myocardial infarction is a likely diagnosis
b) CK-MB levels will be elevated
c) Streptokinase is indicated
d) Pethidine is the drug of choice for analgesia
e) Aspirin improves mortality due to its anticoagulant effect
2. T/F regarding myocardial infarction
a) Bradycardia common in anterior MI than inferior MI
b) Streptokinase is indicated in normal ECG with typical symptoms
c) Beta blocker improves survival rate
d) Aspirin is with held until diagnosed by ECG
e) Statin is given even in normal LDL level
3. What are the treatment options in patient with NSTEMI?
a) Streptokinase
b) Heparin
c) Clopidogrel
d) Warfarin
e) Atorvastatin
4. Regarding stable angina
a) Resting ECG is abnormal in 50%
b) Upward sloping ST segment depression is more suggestive of ischemia
c) May undergo spontaneous improvement with time
d) Treatment with nitrates improve the survival
e) Aortic stenosis may have a similar presentation
5. Regarding unstable angina
a) Hypothyroidism is a risk factor
b) Thrombolytic therapy is indicated in severe disease
c) Men & women are equally affected
d) Troponin T elevated in most cases
6. Regarding thrombolysis in MI
a) If LBBB is present, ST elevation should be confirmed before thrombolysis
b) Arrhythmias during the thrombolysis carry a worst prognosis
c) Q waves may not develop if successful thrombolysis occurs
d) Can be repeated if chest pain recur within 1 week
e) Has a long term mortality benefit
7. Regarding MI
a) Sub-endocardial Ml manifest in specific leads
b) Pericardial rub occurs simultaneously with 1st ECG changes
c) Pansystolic murmur at apex may signify papillary muscle dysfunction
d) Breathlessness may be the only symptom
e) Vomiting is more common with anterior MI
8. A 56 year old male with a past history of myocardial infarction is admitted with sudden onset palpitations. ECG shows a broad complex tachycardia. The patient is conscious with blood pressure of 110/80 mmHg. What is the most appropriate treatment?
a) Carotid massage
b) Intravenous adenosine
c) Intravenous amiodarone
d) DC cardioversion
e) Intravenous digoxin
9. A 45y old male complains of recurrent episodes of left sided chest pain on exertion. Resting ECG is normal, the next most appropriate ix to arrive a diagnosis is
a) Coronary angiogram
b) Brain natriuretic peptide
c) Echo
d) Exercise ECG
e) Troponin I
10. 75 year old woman who has recurrent angina on GTN spray, aspirin, atorvastatin, enalapril and verapamil came to clinic. On examination her BP was 130/80, Pulse 60 bpm. To prevent the above problem what is your appropriate next management?
a) Changing verapamil to diltiazem
b) Changing enalapril to captopril
c) Add beta-blocker d) Give daily oral GTN
e) Reassure that it is normal
11. 55 year old female with diabetes mellitus and hypertension presented to ETU with retrosternal chest pain for 1 hour. ECG reveals 4 mm ST elevation in V1-V6. After excluding all contraindications, streptokinase 1.5 units were given. 2 hours later pain was persistent and there was 3 mm ST elevation in same leads of ECG. What is the best management?
a) Urgent coronary artery bypass graft
b) Rescue PCI
c) Repeat streptokinase
d) S/C enoxaparin
e) IV GTN
Heart Failure (HF)
1. Heart failure
a) MI is the commonest cause of LVF
b) Increased preload can maintain the cardiac output in severe heart failure
c) Rennin angiotensin mechanism is activated
d) Diastolic dysfunction is more common in elderly
e) Pansystolic murmur that best heard in inspiration may occur in LVF
2. Regarding chronic heart failure
a) Arrhythmias is the commonest cause of death in class II of NYHA classification
b) Angiotensin levels are elevated
c) Survival benefit of Furosemide is well proved in clinical trials
3. A 30 year old man who presented with progressive shortness of breathing. He found to have a blood pressure of 80/50 mmHg and elevated JVP with muffled heart sounds. Which of the following are expected findings,
a) Ankle oedema
b) Pulses paradoxes
c) Bilateral basal crepitations of the lungs
d) ECG showing small complexes
e) Globular heart in chest x-ray
4. In heart failure
a) ACE inhibitors are the 1st choice in management
b) Treatment with furosemide reduces the cardiac output
c) Beta blockers are prescribed to relieve the symptoms
d) Calcium channel blockers has special role in diastolic dysfunction
e) Implanted devices has no place in the management f) Digoxin is given only if atrial fibrillation is present
5. Which of the following has mortality benefit in CCF?
a) spironolactone
b) captopril
c) Isosorbide mononitrate
d) furosemide
e) metaprolol
6. Which of the following give survival benefit in cardiac failure
a) Captopril
b) HCT
c) Carvedilol
d) Digoxin
e) Spironolactone
7. A 50 year old man develops shortness of breath and leg swelling while away on a business trip. He was told that he had congestive cardiac failure, but asymptomatic now, with normal vital signs & physical examination. An echocardiogram shows an estimated ejection fraction of 38%. The patient likes to keep medications to a minimum. He is currently on aspirin and simvastatin. Which would be the most appropriate additional treatment?
a) Begin an ACE inhibitor and a beta-blocker on a scheduled basis. b) Begin digoxin plus furosemide on a scheduled basis.
c) Begin spironolactone on a scheduled basis.
d) Begin furosemide plus nitroglycerin.
e) Given his preferences, no other medication is needed unless shortness of breath and swelling occur.
8. A 60 year old previously well male complained of progressive breathlessness, abdominal discomfort and swelling of the legs. On examination there was a gross ascites, elevated JVP, bibasal crepitations and enlarged liver. BP - 180/80 mmHg, RR-25/min, PR - 36 bpm. On ECG heart rate is 96 bpm. What is the best management option?
a) Digoxin
b) Digoxin + Furosemide
c) Furosemide
d) Abdominal paracentesis
e) Transthoracic pacemaker
9. 54 y old man treated for heart failure had SOB in exertion. Had P/Hx of MI back. PR=80 regular, BP=130/90 mmHg. RS Ex normal. CXR-cardiomegaly he is on Furosemide 40 mg, Enalapril 10 mg. next drug?
a) Digoxin
b) Metoprolol
c) HCT
d) Atenolol
e) Losartan
10. 35 year old male with a previous history of STEMI presented with SOB & ankle Oedema after 2/52. Echo showed scarring of the L/ventricle. What is the best drug with survival benefit for this patient?
a) ISMN
b) Carvedilol
c) Diltiazem
d) Warfarin
e) Furosemide
1) Regarding Schizophrenia,
a. Poor prognosis if the onset is young
b. No evidence that there is a genetic predisposition
c. Enlarged ventricles are seen in some
d. Prognosis is better in developed countries
e. Highly expressed emotions increase the risk of relapse
2) Passive symptoms of schizophrenia
a. Blunting of mood
b. Poor speech
c. Auditory hallucinations
d. Poverty of thought
e. Social withdrawal
3) Regarding epidemiology of schizophrenia
a. Life time risk is 1% in general population
b. Onset is typically between 15-35 years of age
c. Onset is earlier in females
d. Incidence is similar worldwide
e. Prognosis is worse in developing countries
4) Following are Schneider’s first rank symptoms of schizophrenia
a. Nihilistic delusions
b. Depersonalization
c. Visual Hallucinations
d. Thought broadcasting
e. Suicidal thoughts
5) Regarding the treatment of schizophrenia
a. ECT is effective in patients with chronic schizophrenia
b. Family psycho-education aiming at reducing emotional over involvement has proved to reduce relapse
c. Antipsychotic medication should be started in high doses and reduced gradually
d. Antipsychotics should not be given for more than a year
e. Behaviour therapy has no place in management
6) Good prognostic factors in schizophrenia
a. Early onset of disease
b. Male sex
c. Presence of affective symptoms
d. Prodromal symptoms for 1 year prior to onset of illness
e. Onset following a stressful event
7) Regarding treatment of schizophrenia
a. An episode should be treated for 1year after symptom resolution
b. Young age has a good prognosis
c. Lifetime risk is 10:1000
d. Concurrent use of anticholinergics reduce the risk of tardive dyskinesia
e. Sodium valproate reduces relapses
8) True or false regarding schizophrenia
a. Has a neurodevelopmental basis
b. Acute symptoms respond to treatment better than chronic
c. Lifetime risk is 10:10000
d. Young patients have a better prognosis than old patients
e. Point prevalence is 5 in 1000
9) Following are characteristic features of chronic schizophrenia
a. Lethargy
b. Hallucinations
c. Disturbed behaviour
d. Formal thought disorder
e. Abnormal movements
10) Features of chronic schizophrenia
a. Elevation of mood
b. Negative symptoms
c. Obsessional phenomenon
d. Loss of self-coping skills
e. Apparent cognitive impairment
11) Schizophrenia
a. Usually begins in old age
b. Usually does not interfere with day to day life
c. Is known to relapse when maintenance medicine is stopped
d. Is the rarest psychosis
e. Carries a very poor prognosis
12) In the treatment of schizophrenia
a. Medication is continued at least for one year after resolution of symptoms
b. Atypical antipsychotics should not be used in young patients
c. Deport preparations are used in patients with poor drug compliance
d. Sodium valproate is used to reduce relapses
e. Rehabilitation is needed for chronic cases
13) The following strongly support the diagnosis of schizophrenia
a. Third person auditory hallucinations
b. Disorientation
c. Visual hallucinations
d. Passivity experience
e. History of sexual abuse in childhood
14) Schizophrenia
a. Is diagnosed based on clinical presentation
b. According to ICD 10 symptoms should last at least 6 months
c. If the symptoms are for less than 1 month it is called acute psychotic disorder
d. 30% of patients will recover
e. Risk of suicide is highest when the disorder is in its early stages
15) True or False
a. Delusional disorder is when one only has delusions without other symptoms
b. In delusional disorder the delusions get encapsulated
c. Schizoaffective disorders may need both antipsychotic and antidepressant or mood stabilizing drugs
d. Primary delusions are common
e. Primary delusions are significant in diagnosing schizophrenia
Answers
01. a) T b) F c) F d) F e) T
02. a) T b) T c) F d) T e) T
03. a) T b) T c) F d) T e) F
04. a) F b) F c) F d) T e) F
05. a) T b) T c) F d) F e) F
06. a) F b) F c) F d) F e) T
07. a) F b) F c) T d) T e) F
08. a) T b) T c) F d) F e) T
09. a) F b) F c) F d) F e) T
10. a) F b) T c) T d) T e) F
11. a) F b) F c) T d) F e) F
12. a) F b) F c) T d) F e) T
13. a) T b) F c) F d) T e) F
14. a) T b) F c) T d) T e) T
15. a) T b) T c) T d) F e) T
